Effect of atenolol on QTc interval lengthening during hypoglycaemia in type 1 diabetes
Open accessAbstract
Aims/hypothesis Hypoglycaemia is associated with heart rate-corrected QT (QTc) interval lengthening on the ECG; this may be important in the pathogenesis of sudden overnight death in young people with diabetes. Since hypoglycaemic QTc lengthening appears to be mediated through the sympathoadrenal response, we tested the hypothesis that beta1-blockade will prevent these changes in type 1 diabetic patients and so provide a potential therapeutic intervention.Methods We studied eight type 1 diabetic adults without cardiovascular or renal complications. Similar hypoglycaemic clamp studies were performed on two occasions, at least 4 weeks apart, but immediately before one visit subjects received atenolol 100 mg daily for 7 days. Following a 60-min euglycaemic (5 mmol/l) period, blood glucose was lowered over 30 min to 2.5 mmol/l, and held for 60 min. High-resolution ECG was recorded at baseline and at 0, 30 and 60 min during each glycaemic plateau. QT interval was measured using a semiautomated tangent method and QTc was derived from QT using the Fridericia formula.Results Mean (SD) baseline QTc was similar at both visits: control 391 (30) ms, post-atenolol 386 (34) ms; (p=0.33). Without atenolol pretreatment, QTc lengthened during hypoglycaemia to a maximum of 448 (34) ms (p<0.001). On atenolol, QTc lengthening was significantly reduced (peak QTc 413 (27) ms; p=0.004 vs control visit).Conclusions/interpretation Hypoglycaemic QTc lengthening is blunted by atenolol in patients with type 1 diabetes. Selective beta1-blockade may help prevent sudden death, if we can identify those at high risk.
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Studies in healthy individuals and individuals with type 1 diabetes have shown that beta-adrenergic receptor blockade can prevent QTc prolongation during hypoglycemia.
“For example, studies in healthy individuals and individuals with type 1 diabetes have shown that blockade of the β-adrenergic receptor is capable of preventing QTc prolongation during hypoglycemia (8, 10).”
From Effect of Hypoglycemia on QT Interval in Individuals With and Without Type 2 Diabetes: A Randomized Crossover Trial (2025) · cites this paper as [10]
The Introduction reports that atenolol largely prevented hypoglycaemic QTc lengthening in non-diabetic subjects. In this study’s type 1 diabetic adults, the Discussion says QTc increases were only partially prevented, so the claim overstates prevention in that group. (LLM, conf=0.90)
Experimental — accuracy not yet measuredHypoglycemia is a reported cause of increased QTc in healthy adults and individuals with diabetes.
“Hypoglycemia is a reported cause of an increase in QTc in healthy adults and individuals with diabetes (7–11, 15).”
From Effect of Hypoglycemia on QT Interval in Individuals With and Without Type 2 Diabetes: A Randomized Crossover Trial (2025) · cites this paper as [10]
Experimental hypoglycemia using hyperinsulinemic clamp protocols impairs cardiac repolarization.
“Studies of experimentally induced hypoglycemia using hyperinsulinemic clamp protocols have shown hypoglycemia-induced impairments in cardiac repolarization (7–11)”
From Effect of Hypoglycemia on QT Interval in Individuals With and Without Type 2 Diabetes: A Randomized Crossover Trial (2025) · cites this paper as [10]
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- Authors
- Lee, S. P., Harris, N. D., Robinson, R. T., Davies, C., Ireland, R., Macdonald, I. A., & Heller, S. R.
- Affiliations
- Northern General Hospital (GB)
- Royal Hallamshire Hospital (GB)
- University of Nottingham (GB)
- Corresponding author
- Heller, S. R.
- Venue
- Diabetologia
- Published
- 2005-05-25
- Volume
- 48
- Issue
- 7
- Pages
- 1269-1272
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2020909129
- Cited by
- 45
- References
- 15
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 1 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 4 · 2015: 3 · 2014: 5 · 2013: 4 · 2012: 2
- FWCI
- 2.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Novo Nordisk UK Research Foundation
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- atenolol, QTc interval, hypoglycemia, type 1 diabetes, beta1-adrenergic blockade, sympathoadrenal response, QT prolongation, sudden cardiac death prevention
- MeSH terms
- Adrenergic beta-Antagonists, Atenolol, Blood Pressure, Diabetes Mellitus, Type 1, Electrocardiography, Female, Heart Rate, Humans, Hypoglycemia, Male, Sweating, Tremor
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